Medical billing doesn’t have to be complicated. One of the best ways dental sleep medicine practitioners can build a successful practice is by ensuring they submit accurate codes and documentation to payers. With the right systems and support in place, medical billing for oral appliances becomes more straightforward. At Nierman Practice Management, we regularly educate dental offices about medical billing updates. Staying informed about these updates helps dental offices navigate medical billing and achieve quicker reimbursement.
One update is that Current Procedural Terminology. (CPT®) 2024 removed the time ranges from office visit codes (Evaluation & Management (E/ M codes). CPT replaced them with a single total time amount. This time “must be met or exceeded” according to the new descriptors. This change refers to both the new and established visit codes. For example, 99203 had a time range of 30-44 minutes. Now, the provider must meet or exceed 30 minutes of total service time to bill this code by time.
Great news! Determining office visit time now extends beyond face-to-face interactions. When selecting your code level, include:
- Preparation for the patient (e.g., reviewing tests)
- Obtaining and/or reviewing separately obtained medical history
- Conducting a medically appropriate examination and/or evaluation
- Counseling and educating the patient, family, or caregiver
- Ordering medications, tests, or procedures
- Entering relevant data into your software
Preauthorization Reform Continues
Legislative efforts are gearing up too. Currently, a bill in Congress mandates 72 hours for an urgent preauthorization request and 7 calendar days or less for standard requests, significantly reducing the timeframes for payer decisions. Many states have recently set stronger mandates for preauthorization.
Getting Your Ducks in a Row:
Utilizing a system for electronic patient registration and history-taking simplifies processes for patients and dentists alike. Verify benefits and establish financial responsibility for oral appliances. Establish a repeatable workflow. Communicate with sleep patients’ physicians to position your practice as the go-to sleep dentist in your area.
Simplifying DSM billing processes and improving communication with local physicians helps dental practices focusing on sleep medicine to thrive.
Contact Us
Nierman Practice Management has empowered thousands of dental practices to successfully treat patients with sleep apnea and TMJ disorders through our renowned continuing education courses. Our industry-leading DentalWriter Plus software simplifies Dental Sleep Medicine and TMJ medical billing by generating detailed SOAP narrative reports, making it easier for dentists to secure referrals and bill medical insurance.
Ready to enhance your practice? Join the many dental professionals who trust Nierman Practice Management to elevate their care and streamline their processes.